During our initial grant period, we compared a regional sample of 82 extremely low birthweight (ELBW, <750 gram) children to demographically matched groups of very low birthweight (VLBW, 750-1499 gram) and full-term (FT) children. According to the results of assessments of these children at early school age, the ELBW group performed less well than the other two groups on neuropsychological and achievement testing, had more behavior and social problems, and were more often placed in special education programs. Parents of the ELBW children reported higher levels of distress than parents of children in the higher birthweight groups. Health and developmental problems, which are more common in the ELBW group, were also associated with higher rates of psychological symptoms n parents. The purpose of this continuation proposal is to follow these three groups of children as they progress through school. A more recent birth cohort will be added to our sample to investigate outcomes in later-born children and to increase sample size to approximately 100 children per group. A series of four consecutive annual assessments is planned, each involving child and parent assessments similar to those employed in our initial study. The child's health status also will be monitored at each evaluation, and teachers will provide end of year educational status reports. Three hypotheses will be tested. Hypothesis 1 is that ELBW children will acquire skills at a slower rate and show increasing vulnerability to behavior and learning problems with age. Hypothesis 2 is that adverse changes in the child will be accompanied by increasing parent distress and family dysfunction. Hypothesis 3 is that several factors in addition to birthweight will predict age-related changes in child outcomes, including neurosensory and health conditions, developmental and behavioral status at the onset of follow-up, and social-familial variables. Tests of these hypotheses will enhance knowledge of the longer-term consequences of prematurity and of processes accounting for stability or change over time in individual children. Findings also will lead to improved identification of high risk children and will clarify needs for intervention.